Sample IRS Form SS-4 Application for Employer Identification Number (Home Health Care Service Recipients)

IRS Form SS-4, "Application For Employer Identification Number For Home Health Care Service Recipients" is a tax form issued by the United States Internal Revenue Service. The latest version of the form was released in January 1, 2010. A up-to-date SS-4 Form in PDF is available for download below.

The IRS-issued "Application For Employer Identification Number For Home Health Care Service Recipients" is available for digital filing or can be filled out through the Adobe Reader application on your desktop or mobile device.

ADVERTISEMENT
Record EIN here when
EINs cannot be applied for online for participant
received. This box is left
direction employers. EINs must be obtained via
blank until EIN is received.
phone, fax or mail using Form SS-4.
Employer can be
participant or
representative serving
as employer. After
employer name, enter
“HHCSR”
Leave Line 2 blank.
Participant employer
should generally not be
established as an LLC
or corp.
Leave 9b blank.
As a default, leave Box
14 unchecked.
Enter 0 in all boxes.
Do not enter any other
number in these
boxes.
In most cases, “no”
should be checked.
Individual listed in Box 1 should sign, date and print name, telephone and fax (if applicable) here. An exception is if a guardian
for the individual listed in Box 1 has been court appointed. If a guardian for the person listed in Box 1 has been court
appointed, guardian should sign, date and attach copy of court appointed guardianship papers with court seal visible.
Example IRS Form SS-4
Used to Obtain Federal Employer Identification Number for a Participant Hiring Employees and Using a
Fiscal/Employer Agent
Record EIN here when
EINs cannot be applied for online for participant
received. This box is left
direction employers. EINs must be obtained via
blank until EIN is received.
phone, fax or mail using Form SS-4.
Employer can be
participant or
representative serving
as employer. After
employer name, enter
“HHCSR”
Leave Line 2 blank.
Participant employer
should generally not be
established as an LLC
or corp.
Leave 9b blank.
As a default, leave Box
14 unchecked.
Enter 0 in all boxes.
Do not enter any other
number in these
boxes.
In most cases, “no”
should be checked.
Individual listed in Box 1 should sign, date and print name, telephone and fax (if applicable) here. An exception is if a guardian
for the individual listed in Box 1 has been court appointed. If a guardian for the person listed in Box 1 has been court
appointed, guardian should sign, date and attach copy of court appointed guardianship papers with court seal visible.
Example IRS Form SS-4
Used to Obtain Federal Employer Identification Number for a Participant Hiring Employees and Using a
Fiscal/Employer Agent

Download Sample IRS Form SS-4 Application for Employer Identification Number (Home Health Care Service Recipients)

760 times
Rate
4.6(4.6 / 5) 38 votes
ADVERTISEMENT